What does a Spravato treatment course entail for depression? Will I need maintenance treatments?

By William Rayburn MD, MBA

Spravato Clinic Director, Sweetgrass Psychiatry

After your successful initial dosing, the manufacturer recommends twice weekly dosing during the first 4 weeks as the true “induction” period. The second 4 weeks (weeks 5 to 8) consist of administering the same dose either once weekly if you demonstrate a response or twice weekly if there is no response.

If the medication is continued beyond 8 weeks (maintenance period), the dosing regimen will be tailored according to your needs by inhaling the most effective dose (56 mg or 84 mg) and the least frequently to maintain a remission or response. By the beginning of week 9, I will discuss three options with you to consider. Together, we will choose one of the following: 1) take the drug every one or two weeks, 2) take the drug only if you feel symptoms are worsening (“rescue dose”), or 3) discontinue esketamine if there is no response and consider other therapy options with your provider.

In most cases, patients respond to esketamine and continue with regular dosing usually every 2-3 weeks. Infrequently, they will require redosing weekly or monthly. Stopping the medication after a response is uncommon and usual among those who have consistently mild depression.

If you have treatment resistant major depression, live in the Charleston SC or Mount Pleasant, SC area and are interested in scheduling a Spravato consultation, please call Sweetgrass Psychiatry at (843) 800-1303.